SCIENCE@home

Does Diabetes Always Confer Coronary Heart Disease Risk Equivalent to a Prior Myocardial Infarction?

E. Boyko,J. Meigs

Published 2011 in Diabetes Care

ABSTRACT

The excess risk for future coronary heart disease (CHD) events attributable to diabetes alone in the absence of coexisting CHD was not well understood until the publication by Haffner et al. (1) on this subject in 1998, which concluded that the elevation in risk was essentially similar to nondiabetic individuals with a prior myocardial infarction. This conclusion was based on a nonsignificant adjusted hazard ratio of 1.2 for CHD mortality over 7 years of follow-up in a Finnish cohort. This article had a considerable impact on our thinking and approach to CHD prevention in diabetes given its publication in a prestigious medical journal and high number of citations since ( n = 3,676; scholar.google.com, accessed 4 October 2010). It provided justification for taking the same intensive approach to CHD prevention as used in individuals with a prior myocardial infarction, including aspirin as a cornerstone of treatment. In apparently equivalent high-risk states of diabetes and prior CHD, the benefit of aspirin in reducing risk of myocardial infarction has been believed to outweigh uncommon bleeding complications and yield a net average expected benefit. Given the finding of Haffner et al. and previous American Diabetes Association (ADA) recommendations in favor of the use of aspirin to prevent CHD in many individuals with diabetes, why then would a recent ADA position statement change course by recommending more limited aspirin use based on overall cardiovascular disease (CVD) risk (2,3)? A number of reasons seem to justify this change in recommendations. There have been major advances in treatment approaches to type 2 diabetes, replications of the finding by Haffner et al. are inconsistent, and recent data suggest that the utility of aspirin for CHD prevention may be of a lesser magnitude than previously believed. First, it should be pointed out that even though …

PUBLICATION RECORD

CITATION MAP

EXTRACTION MAP

CLAIMS

  • No claims are published for this paper.

CONCEPTS

  • No concepts are published for this paper.

REFERENCES

Showing 1-25 of 25 references · Page 1 of 1

CITED BY

Showing 1-15 of 15 citing papers · Page 1 of 1